The overall objective of the Evaluation was to inform the evidence base for future policy direction and implementation of suicide prevention activity, and to put in place a comprehensive evaluation framework for ongoing use. This final report provides an analysis of the appropriateness, effectiveness and efficiency of NSPP-funded projects from 2006 to 2013.
The initial retrospective evaluation of the projects encountered many data limitations. These were addressed by obtaining more comprehensive data about project activities from the MDS (Appendix C) and through in-depth consultations with stakeholders. Direct engagement with funded organisations has been one of the strengths of the current evaluation and differentiates it from prior evaluations where such engagement was not possible.
As a result, this evaluation represents the most extensive evaluation of NSPP-funded activities to date, and provides government with a solid foundation upon which to base future program-related decisions. Data derived from the MDS has been particularly valuable in this regard. Prior to the implementation of the MDS, existing project data could only be used to generate a broad overview of project activities. While areas of activity could be established, the scale of this activity was unknown. Likewise, a refined analysis of activities could not be undertaken including participant demographics, target groups, and referral pathways, for example.
This final report is based on MDS data for only a six month period (October 2012 to March 2013), however it provides an essential baseline for future measures. The Department’s decision to extend MDS data collection for a further 12 months to May 2014 means that comparable data on NSPP-funded activities will ultimately be available for a 20-month period.
Despite these achievements and advances, information gaps still remain. This is particularly true in relation to outcome measurement. While the MDS has contributed greatly to the process evaluation of the NSPP, outcome measurement represents the next major frontier for NSPP evaluations. Without outcome measurement, the question of 'what works for whom in what circumstances, in what respects, and how' will remain unanswered. So too, will questions of economic efficiency.
Consequently, at this time it is not possible to assess whether alternative configurations of suicide prevention activities funded under the NSPP would be beneficial. This Evaluation found that the current community-based approach appears to be responsive to local need. However the absence of outcome measurement has impeded comparison of this approach with potential alternative future strategies, such as:
- Smaller number of larger programs
- Different mix of larger and smaller programs
- Delivering services and influencing behaviour through online mediums, including social media.
Such a task is beyond the remit of individual funded organisations. Although this would represent an additional cost to government, the returns in terms of national consistency in measurement and comparability across projects would be great. Importantly, it would provide more robust information on which to base decisions about which projects should be continued, expanded upon, refined or eliminated. Incorporation of appropriate outcome measurement would also enable learnings from the NSPP to inform the international evidence base.
Nonetheless, despite these information gaps at project level, this Evaluation provides important insights for decision makers. Recent evidence of what works is summarised and consolidated in the literature reviews, while the extent of community support for NSPP projects serves as a strong indicator of the perceived appropriateness of suicide prevention activities at local level.
Going forward, organisations funded to undertake suicide prevention activities, the government funding these activities and, ultimately, those at risk of suicide can benefit from the opportunities for program improvement identified in this report. Top of page
13.7.1 Scene setting going forwardThe social and environmental factors related to suicide are complex and dynamic. As a result, outcome measurement will need to evolve as new risk and protective factors are identified and new programs and initiatives are implemented in response. One key emerging area is the impacts of social media and the internet on suicide and self-harm risk. These impacts may be negative (eg, through exposure to methods of self-harm or suicide) or positive (as a medium for service provision for some groups).
The recent developments and investments in e-mental health highlight the importance of these different service delivery modalities in providing treatment and support to people with mental health disorders. The utility of these modalities in the suicide prevention arena needs further investigation, including consideration of the age appropriateness of social media and the internet as modes of service delivery.
Policy and funding changes also add to the dynamic landscape of suicide prevention in Australia. The introduction of Australia's first National Aboriginal and Torres Strait Islander Suicide Prevention Strategy is one such example. Released in May 2013 and supported by funding of $17.8 million over four years (2013-14 to 2016-17), this new strategy prioritises local, community-led activities developed in close consultation with Aboriginal and Torres Strait Islander communities.
The strategy will provide opportunities to overcome many of the challenges related to the cultural appropriateness of services as well as the tools and approaches used for monitoring and evaluation purposes. With this development comes the question of whether projects that target Aboriginal and Torres Strait Islander populations are now more appropriately the domain of the new strategy rather than the NSPP.
There has been increased attention given to the local coordination of primary care. These coordination mechanisms offer the potential to further refine and integrate suicide prevention activities. This could include increased opportunities for collaborative engagement such as training for gatekeepers, including GPs and other health professionals.
Another important consideration is the NSPP’s positioning relative to other activities being undertaken with at-risk groups targeted by the NSPP. This includes non-NSPP funded suicide prevention organisations and wider mental health activities such as headspace and beyondblue. Possibilities for synergies between the NSPP and other players need to be considered
Australia's long history of migration has resulted in it being the second most multicultural nation in the world.116 This poses particular challenges for suicide prevention activity given the cultural and linguistic diversity of this immigrant population. These challenges are further compounded by the complex needs of refugee and humanitarian immigration streams.
These examples highlight the need to regularly review the range of projects that remain under the NSPP as policy and funding changes occur.